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Oral Hygiene in Assisted Living


This study will evaluate a program that provides daily mouth care for assisted living residents with dementia, with the goal of reducing bacteria in the mouth that lead to aspiration pneumonia. The project will develop methods that can be taught to assisted living caregivers by community dental hygienists.

Minimum Age Maximum Age Gender Healthy Volunteers
18 Years N/A All No
October 1, 2019
June 30, 2023

Assisted Living Staff

  • Able to read and speak English fluently
  • Provide direct care to residents in participating assisted living community

Assisted Living Residents

  • Have teeth or have teeth and use a denture
  • Diagnosis of dementia 

Dental Hygienists

  • Public health dental hygienists not employed by the North Carolina Department of Health and Human Services

Assisted Living Residents

  • Does not receive mouth care from assisted living staff
  • Requires antibiotic prophylaxis prior to oral hygiene examination
  • Currently receiving hospice care or tube feeding
  • Expected to die or be discharged in the next 6 months

Many people with dementia resist mouth care. As a result, only 16 percent have their teeth brushed regularly, putting them at risk for aspiration pneumonia when they inhale bacteria from their teeth, tongue, and gums. A dementia-focused mouth care program for nursing homes, Mouth Care Without a Battle (MCWB), has become a standard of nursing home care and will now be tested in 24 assisted living facilities in North Carolina in partnership with he North Carolina Department of Health and Human Services (DHHS) Special Care Dentistry Program.

Half of participating assisted living communities will use MCWB, and half will use standard oral hygiene for 8 months. A research dental hygienist will train assisted living staff on MCWB and provide ongoing support. This responsibility will then be transferred to community-based public health dental hygienists working with the DHHS. Researchers will interview assisted living staff and trainers to assess the extent to which care has changed and gather recommendations for program modifications. 

MCWB has been shown to change caregivers' attitudes and behavior, improve residents' oral health, and reduce pneumonia incidence. This study will lay the groundwork for a pragmatic clinical trial and real-world implementation of MCWB for assisted living residents with dementia and their caregivers.

Name City State Zip Status Primary Contact
University of North Carolina at Chapel Hill
Chapel Hill North Carolina 27599 Recruiting Sheryl Zimmerman, PhD

University of North Carolina, Chapel Hill

  • National Institute on Aging (NIA)

Name Role Affiliation
Sheryl Zimmerman, PhD Principal Investigator University of North Carolina, Chapel Hill

Name Phone Email
Kimberly T Ward, BA 919-843-7811


Adapting an Evidence-Based Program That Improves Oral Hygiene and Health for Assisted Living Residents With Dementia